| NPI | 1902863640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NM NM92284) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: VA 0101026463) |
| Enumeration Date | 2006-04-27 |
| Last Update Date | 2016-11-03 |